Administrative and Judicial FTCA Claims Process Tort claim presented to appropriate Federal agency within 2 years after claim arises (28 U.S.C. §2401(b)) No duplication of insurance coverage: U.S. pays Duplication of coverage and insurance company refuses Duplicative coverage and insurance company accepts its payment responsibility: company pays up to Attachment 10 The Experience of Community and Migrant Health Centers under the Federal Tort Claims Act (FTCA) The experience of community and migrant health centers is similar to the experience of tribes and tribal organizations under the FTCA. Federally-supported community and migrant health centers and their clinical personnel have been covered under the FTCA for malpractice claims filed against them since January 1, 1993. In extending FTCA coverage to the health centers, the Congress intended to allow the centers to continue meeting the pressing health care needs of their patients and communities while significantly reducing the centers' need for, and the costs of, privately-purchased malpractice coverage. However, coverage was extended for an initial period of only three years, and its scope excluded some important health center activities and personnel, making it necessary for most covered health centers to continue purchasing at least some level of private malpractice insurance, while some were forced to severely restrict or eliminate vital services. Some of these problems and coverage gaps were addressed in later legislation amending and extending this FTCA coverage. Background and History The federal community and migrant health center programs were established more than 30 years ago to provide grant support to local public and private nonprofit organizations for the development and operation of service delivery sites that furnish health care services to residents of medically underserved communities. In 1995, some 722 federally-supported health center organizations operated more than 2200 local health center service sites providing health care to Center for Health Policy Research more than 8.1 million people -- including 3 million people who have no health insurance -- in urban and rural underserved communities across the country. The centers are a vital source of needed health care for low income populations, with two-thirds of those served having incomes below the federal poverty level and 86 percent below twice that level. Nearly half of all health center patients are children and adolescents, and 31 percent are women of child-bearing age. Last year, health centers provided prenatal care, delivery, and postpartum care to nearly 400,000 mother-infant pairs -- 1 of every 10 live births in the U.S. The ability of local health centers to serve the growing numbers of underserved Americans over the years has been aided by their close relationship with another federal program, the National Health Service Corps (NHSC). Originally established in 1970, the NHSC has recruited and placed thousands of primary care physicians and other health professionals in areas with severe primary care health care shortages. Most NHSC placements over the years have been at health centers, and today slightly more than half of the nearly 2000 NHSC-placed health professionals are found at health centers. Initially, all NHSC professionals were federal employees, and as such were covered for medical malpractice claims under the FTCA. Beginning in 1983, however, the employment of these professionals was transferred to their local sponsoring organizations. While local health centers did receive some additional federal support to compensate for this transfer of employment responsibility, no provision was made for the cost of privately-purchased malpractice insurance for these new health center employees. Center for Health Policy Research |